Health care prices can double from one South Florida hospital to the next

Need your appendix out? Go to JFK Medical Center in Atlantis and the bill is $65,500, on average. But at West Boca Medical Center, it's $27,500.

Got pneumonia? Recuperate at Florida Medical Center in Lauderdale Lakes and the bill is $41,200. But at Cleveland Clinic in Weston, it's $15,325.

Such huge price differences – drawn from estimated average charges that hospitals must report to the state each year – are the reality in health care. It's a business in which almost no procedure has a set price, and patients rarely are charged the same amount for the same thing.

A Sun Sentinel check of average prices for four common conditions shows that some institutions charge as much as double, or more, as others. In general, corporate-owned hospitals charge much more than nonprofits or public facilities.

Almost no one pays full price, thanks to due to insurance coverage and or discount programs for the uninsured. Still, hospital and patient advocates said it can be worthwhile for consumers to shop around.

In the national health-care debate in Washington, making charges simpler and clearer has emerged as a pressing need to boost competition, educate consumers and eventually to help lower costs, officials said.

"You're not going to know how much your hospital care is going to cost until your health care episode is over," said Bruce Rueben, chief executive of the Florida Hospital Association. "That's not the way it should work. Surely it will affect your trust in your hospital."

That reality made Steve Baughan angry. When belly pain sent him to the emergency room at University Hospital and Medical Center in Tamarac a year ago, the unemployed construction manager had basic coverage with a high deductible. He counted himself lucky because he went home in three hours.

Then came the bill: $18,500, including $12,000 for two CT scans, $2,150 for blood tests, $130 for a gauze wrap. His insurer covered only a few hundred. He later learned other hospitals may have charged as little as $11,000.

"I absolutely flipped out. I could not believe it. They can charge whatever they want, and there's absolutely no recourse you can take," Baughan said. University is negotiating the charges since he filed a grievance with the state protesting the bill.

University's parent, the national chain HCA Inc., commented by issuing a statement saying all of its hospitals have counselors who meet with patients to discuss costs and payment plans.

"We've found that our patients are grateful for the care we provide and with regard to their bills, most just want to understand what to expect," HCA said.

The Sun Sentinel compared hospital prices from a large state database that lets consumers compare hospitals on treatments and procedures for dozens of ailments, found at http://www.healthfinder.gov.

The uninsured bear the biggest burden from the steady rise in hospital prices. Hospitals say they give the uninsured discounts similar to those they give the insured. Consumer advocates say patients without coverage sometimes are asked to pay full price.

"The situation for the uninsured in South Florida has gotten progressively worse," said K.B. Forbes, director of Consejo de Latinos Unidos, a California group promoting lower prices for the uninsured.

In general, big charges, such as $5 aspirins, are fiction. Hospitalscollect only 20 percent to 30 percent of the bill, on average, because of all the discounts they allow, state and federal figures show. Hospitals negotiate prices with insurers and often give them big discounts to get their business.

Hospital keep using the full prices because some insurers and grant programs pay a percentage of the bill, said Linda Quick, chief executive of the South Florida Hospital and Healthcare Association.

Prices vary wildly among hospitals because each has its own mix of patients, salaries, overhead, debts and insurer contracts, she said.

Hospitals may raise list prices yearly in hopes of collecting more from insurance companies, Quick said. That's to offset the losses they take on patients who don't pay and patients with Medicare and Medicaid, which pay less.

Some hospitals keep prices lower simply by keeping patients fewer days and doing fewer tests, the exception in South Florida, which is known for very high usage of health care. Cleveland Clinic Hospital in Weston had the lowest average prices because, in part, it held patients for fewer days. A key: its doctors are employees with no motive to increase billings, said Dr. Bernardo Fernandez, chief executive.

"We don't have any incentive to admit more patients or keep people for more time or do more procedures," Fernandez said.

Competitors were skeptical. Tenet Healthcare, a chain with some of the highest list price, said the key is how much a hospital's patients and insurers actually pay, not the size of the bills.

"Our rates with managed care companies, which are more reflective of what patients actually pay, generally are below the top of market," Tenet said in a statement.

HCA has taken one step to help consumers understand prices better, setting up a "Patient Financial Resource" on its hospitals' Web sites that give patients an upfront estimate of the hospital bill.

High charges, if pegged to high costs, do not necessarily mean high quality care. A February study in the Journal of the American Medical Association found that hospitals with low costs did not have higher risks of patients dying and did not readmit more patients with complications, said main author Dr. Lena Chen at the University of Michigan. She did not determine if high-cost hospitals were wasteful or thorough.

It's worth shopping for price even if insurance dictates which hospital you use, Quick said. You generally pay less at hospitals with lower list prices. But, she said, don't pick a hospital based on price unless it is also well qualified for the treatment you need.

"Pay attention to price when you can," Quick said. "If the doctor says you need a knee replacement and ‘I have privileges at this hospital and that hospital,' you can go home and look up their prices."

Federal and state officials rate how well hospitals perform, by measuring death rates, infection rates, how often they use the best treatments, how well they try to prevent complications and how often patients must return to the hospital for the same illness. The federal ratings compare a hospital's...